Overcoming Therapeutic Bottlenecks of Infected Bone Defects via 3D-Printed Scaffolds Integrated with Antibacterial, Osteogenic and Angiogenic Synergistic Functions

Abstract

Infected bone defects (IBDs) triggered by open fractures, implant-related infections, chronic osteomyelitis and bone tumor resection remain intractable orthopedic complications, contributing to elevated disability rates, recurrent infection, prolonged treatment courses and heavy social-economic costs. Conventional treatments such as bone grafting and antibiotic-loaded bone cement are plagued by donor shortage, immune rejection, uncontrolled antibiotic leakage and poor anatomical matching, incapable of synchronously eradicating bacteria, inducing osteogenesis and reconstructing blood vessels. Benefiting from personalized shaping, accurate structural modulation, tunable porous structures and broad material adaptability, 3D printing has become an advanced manufacturing method for patient-specific bone scaffolds. The construction of triple-functional scaffolds integrating antibacterial, osteogenic and angiogenic effects is critical to overcome current IBD treatment limitations and facilitate the clinical transformation of bone engineering materials. This review first addresses clinical drawbacks of IBD management and the superiority of 3D printed scaffolds. We systematically recapitulate matching materials, prevailing printing techniques, biomimetic design schemes and biological assessment systems, compare various antibacterial modalities, summarize translational achievements and analyze existing clinical transformation obstacles. Future orientations covering responsive intelligent scaffolds, 4D printing and combined therapies are proposed. This work delivers theoretical guidance for basic research and clinical application of 3D printed antibacterial bone scaffolds.